Antibiotics Sold Without Prescriptions

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FRIDAY, Oct. 1, 2004 (HealthDayNews) -- In many Hispanic communities across the United States, people can buy antibiotics as easily as aspirin, with no prescription and no questions asked, new research suggests.

"In this country, you are supposed to get a prescription for antibiotics," said study author Elaine Larson, an associate dean and professor of pharmaceutical and therapeutic nursing at the Columbia University School of Nursing. However, in many Latin American countries, antibiotics are sold without a prescription, she added.

The practice is troubling, according to Larson, because not every antibiotic works for every illness and you need to be tested to find out what the infection is before the right antibiotic can be prescribed.

Another reason why prescriptions are necessary is to prevent the misuse of antibiotics. When these drugs are overused, there is a greater likelihood that the bacteria being treated will become resistant to antibiotics, Larson added.

"If people are using antibiotics too much, we will have whole neighborhoods or areas where bacteria are resistant to antibiotics," she stressed. Larson presented her findings Sept. 30 at the Infectious Diseases Society of America annual meeting in Boston.

To find out if antibiotics were available without prescriptions, Larson and her colleagues tried to buy them over the counter in several neighborhoods in New York City. "We sent young women out to three communities," Larson said. "One was in central Harlem, one was in Washington Heights, which is primarily Hispanic, and one was on the Upper West Side."

The women were sent to small convenience stores and bodegas, where they asked "if they had anything for a sore throat." They never asked for antibiotics directly, Larson said.

Larson's team found that in the Hispanic community of Washington Heights, the women were able to buy antibiotics in bodegas without a prescription. However, in stores in Harlem and on the Upper West Side, the investigators were not offered antibiotics, Larson noted.

This problem is most likely common in areas where there is a large Hispanic population, Larson said. "In most South and Central American countries you can just go to the store and buy antibiotics. It's not that people are trying to sneak or do something illegal," Larson explained. "That's what they're used to."

Larson said that money doesn't appear to be a motive for the bodega owners, since these antibiotics are being sold for as little as 25 cents a pill. "They are not doing it to make a lot of money," she said. "They are doing it to provide a service."

Most people who buy antibiotics this way know they are not supposed to, Larson said. "But the main concern they have is that it takes so long to go to a clinic and sit and wait for an appointment. It's an issue of access and convenience as much or more than money."

Most of the antibiotics they bought had Spanish labels, which means they were brought in from Latin America, she said.

Larson believes this problem likely exists in other urban Hispanic communities in the United States.

She said she is working with the Bodega Association of the United States, which represents 7,000 stores throughout New York state, to find the best way to educate bodega owners about the problem of selling antibiotics without a prescription.

Efforts by HealthDay to contact the president of the bodega association were unsuccessful.

Dr. Stuart Levy, a professor of molecular biology and microbiology at Tufts University School of Medicine, is an expert on antibiotics. He said, "I have heard about these little enclaves of over-the-counter antibiotic sales among Hispanic communities on the Texas/Mexico border, and in New York and other areas, where there are shops catering to immigrants from countries where antibiotics are generally sold that way."

"I don't think anyone could say how much this one misuse contributes to the antibiotic resistance problem," Levy said. It does point out, however, that antibiotics are not handled carefully enough, he added.

Levy thinks the U.S. Food and Drug Administration should crack down on this practice. "There should be an explanation to these populations that this over-the-counter use is not condoned," he said.

Levy also fears that overuse will increase antibiotic resistance in this population, as is already happening in developing countries.

Dr. George C. Benjamin, executive director of the American Public Health Association, added, "This finding is extraordinarily troubling. These folks are breaking the law."

Benjamin worries that by giving antibiotics without a prescription, someone who is allergic could be killed. He also worries about increased antibiotic resistance.

"I don't know anything about the quality-control efforts of these medications," Benjamin said. "Are they really antibiotics? Are they what they say they are?"

"The store owners need to be told they are breaking the law," Benjamin said. "The FDA and state authorities need to clamp down on these folks."

An FDA official acknowledged the problem.

"These are drugs that FDA has determined that need a physician as an intermediary to ensure that they are used properly," said agency spokeswoman Christine S. Parker. "We can also say that resource limitations generally prevent FDA from taking enforcement actions directed at individual retail outlets, but we frequently refer cases like this that we learn about to state and local public health authorities."